Abstract 723
Historical Perspectives Poster Symposium, Saturday, 5/1
As the 19th century ended, the over riding issue in pediatrics was the feeding of infants, particularly the idea of what was "safe" or "clean" milk in an era plagued by high infant mortality rates (> 200 deaths per 1000 births) to which infantile diarrhea was a major contributor. In fact, this period could be called the decade of "safe milk". Several choices were available-certified milk, pasteurized milk (heated to 167 degrees F),and sterilized milk (212 degrees)-and the proceedings of the APS during this decade are full of discourse on this topic. The Certified Milk movement was lead by Dr.Henry L.Coit (1854-1917) of Newark, NJ, after attempting to obtain "safe milk" for his infant son who died during a typhoid fever epidemic. The goals were to supply raw milk with "uniform nutritive value, reliable keeping qualities, and freedom from pathogens." Dr. Coit's efforts led to the founding of the American Association of Medical Milk Commissions, which developed standards for the production of milk and for dairy sanitation. One of his most important supporters was Dr. Thomas Morgan Rotch (1849-1914), the first professor of Pediatrics at Harvard and third APS president (1891). He, like Dr. Coit, believed that clean "raw" milk was best for infants and he established the Walker-Gordon Certified Milk Laboratory (1891)in Boston which eventually opened branches in 20 large cities in the US and Canada as well as London, England. In addition to providing safe clean milk(< 10,000 bacteria per cubic ml), the Milk Laboratory as established by Rotch also dealt with the problem of milk modification with "safe" ingredients, and particularly his very complicated "percentage feeding method". The latter was both lauded and vilified by practitioners of the time. Though Rotch ultimately became a supporter of pasteurization, by 1910 the milk laboratories he had founded had largely disappeared and the percentage feeding method was on the wane. This was largely due to its complexity (most practitioners were overwhelmed by the mathematical calculations required to write the "formulas") and severe economic restraints, as only the wealthy could afford such a product. Furthermore, efficacy was never demonstrated, even though Rotch's 1891 APS Presidential address called for the use of the scientific approach to problems of infancy. The development and success of the home movement for milk preparation/modification also led to the demise of certified milk and the milk laboratory. However, the concepts of "clean milk" and sanitation practices for dairy and milk production were permanently established through this work. Though the decade of the 1990's may go down in history as the decade of immunizations, the concerns for efficacy, cost-effectiveness, and safety are still of primary concern whether it be the initiation of universal roto-virus immunization or the addition of extra-long chain fatty acids to infant formulas.
